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, CHECK OFF LIST FOR ISSUANCE OF PERVIITS <br /> � FOR OFFICE USE ONLY - . <br /> ADDRESS OR LEGAL: l�t�d �P r�-nr s A�v�. <br /> PID: <br /> DESCRIPTION OF WORK: fl`.�,►c <br /> ZO�G REY��V BY: DATE APPROVED: z -�6• d� <br /> �. BL'II�DLVG REVIE�BY: � � DATE APPROYED; z•c t• oc� <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT Yes ,/ No <br /> pLAN REV�W � Yes �/' No SEtiVER CO�'F;CTION <br /> STATE SURCHARGE Yes �/ No tiVATERCONNEG"ITON <br /> INVESTIGATION FEE Yes No PARK FEE <br /> SAC Yes No STTE��PECTION <br /> Number of SAC-Units OTHER(specify) <br /> _____________-----______� <br /> ZO�Zti'G CH�CK LIST zoning Districc: tz 2-�� <br /> Fire Departmeat: (.,o�.,�U�c.�: Post Office: �r.� . School Dssict: b Nn <br /> Lot Area: Sq.ft. 2s.��q•�S Acres .S� ' Width �83_a9 Depth /3 y <br /> Survey Submitted: Yes_ L� No Date of Survey: �� F'��'- <br /> Proposed Setbacks: � <br /> Front(Lake): 4� Rioh.t Side: �3� _ - � . <br /> Rear(Street): q� Left Side: ?1 <br /> Adjacent Structures: Z l � Wetland: /V �/� <br /> Building Height: Def. Hgt. IV I�°► Peal:H;t. <br /> Lot Coverage: D•I� ' <br /> Gradir.g: Staff Approval Date: -- By: Council Appro��z1 Date: <br /> Septic: Scaff Agproval Date: — By: <br /> Zoning File: # — � Resolution: # Resoludon Date: �. <br /> Shoreland District: y+GS <br /> Av;. Setback: rv lA� B1uffSetback: ^! I�r LocCo�-era�e: � 1,� <br /> � E7ci5Cmg Progos�d <br /> Hazdcovcr: 0-?5' p�� <br /> . 75-250' ---- <br /> 250-500' <br /> 500-1000' <br /> Hardcover Variaace Required: Yes No '� Date of CouncL Approval: _ <br /> REI�IARKS ('in house): � <br /> 7 <br />